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Original Article | Open Access

Risk factors for esophagogastric variceal-related poor outcomes in primary biliary cholangitis: A prospective cohort study

Lin Hana,1, Huan Xiea,1, Xue-Mei Maa,1, Xiao-Long Luc, Jun Zhaoa, Qing-Sheng Lianga, Zheng-Sheng Zoua( ), Jing-Feng Bib( ), Bo Jina( ), Ying Suna( )
Senior Department of Hepatology, The Fifth Medical Center of PLA General Hospital, Beijing 100039, China
Senior Department of Infectious Diseases Medicine, The Fifth Medical Center of PLA General Hospital, Beijing 100039, China
Graduate School, Medical School of Chinese PLA, Beijing 100039, China

1 Han L, Xie H and Ma XM contributed equally to this work.

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Abstract

Background and aims

Esophagogastric varices (EGV) are common complications of primary biliary cholangitis (PBC). We examined the risk factors for variceal bleeding-related liver transplantation (LT) or death.

Methods

This prospective observational cohort study involved PBC in our hospital from 1 January 2005 to 1 January 2020. The clinical endpoints were variceal bleeding-related LT and death. Survival analysis was performed using the Kaplan–Meier estimate, cox regression analysis was performed to investigate risk factors.

Results

PBC with EGV had significantly shorter survival than those without (p = 0.002). Endoscopic prophylaxis significantly improved poor outcomes in PBC with EGV (p < 0.001). Risk factors in patients with EGV included: cholinesterase (CHE) of <1.0 × upper limit of normal (ULN), international normalized ratio (INR) of >1.2 × ULN at baseline, total bilirubin of >1.2 × ULN, aspartate aminotransferase (AST) of >2.3 × ULN after 1 year of ursodeoxycholic acid (UDCA) treatment, non-biochemical responders according to the Paris criteria, and no history of endoscopic therapy. In PBC without EGV, risk factors included AST of >2.3 × ULN, INR of >1.2 × ULN at baseline, CHE of <1.0 × ULN after 1 year of UDCA treatment, and GLOBE score of >1.125.

Conclusion

This study provides evidence that AST, INR and CHE are major risk factors for variceal bleeding-related poor outcomes in PBC. For PBC with EGV, a good biochemical response to UDCA and endoscopic prophylaxis may improve survival. These findings can aid for guiding initial PBC risk stratification and screening endoscopy in patients without EGV.

Keywords

Risk factorsPrimary biliary cholangitisEsophagogastric varicesUrsodeoxycholic acidLiver transplant-free survivalEndoscopic therapy

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iLIVER
Volume 3 Issue 1,
March 2024
DOI: 10.1016/j.iliver.2024.100081
Cite this article:
Han L, Xie H, Ma X-M, et al. Risk factors for esophagogastric variceal-related poor outcomes in primary biliary cholangitis: A prospective cohort study. iLIVER, 2024, 3(1). https://doi.org/10.1016/j.iliver.2024.100081

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Received: 20 November 2023
Revised: 03 January 2024
Accepted: 13 January 2024
Published: 08 February 2024
© 2024 The Authors. Tsinghua University Press.

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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